Three-Dimensional Modeling of Bronchovascular Anatomy for Preoperative Planning and Intraoperative Guidance in Uniportal Video-Assisted Thoracoscopic Segmentectomy

Abstract

Background: This study aim to evaluate the feasibility of threedimensional (3D) modeling using open-source free software for preoperative planning and intraoperative guidance in uniportal video-assisted thoracoscopic segmentectomies. Methods: Between October 2020 and November 2023, 50 patients (27 males, 23 females; mean age: 60 +/- 11.1 years; range, 34 to 78 years) who underwent uniportal video-assisted thoracoscopic pulmonary segmentectomy with preoperative 3D modeling were retrospectively analyzed. Preoperative 3D modeling was performed using computed tomography with an open-source 3D software program. The virtual models exported to the mobile device were compared with the anatomical structures of the patient intraoperatively. The patients were divided into two groups as simple and complex segmentectomy according to the characteristics of the surgical procedures. Results: The overall matching success rate of the virtual 3D models with intraoperatively identified bronchovascular structures was 99.27%. The overall variation rate was 36% (n=18) among all patients. There was a significant difference between the two groups in terms of the bronchovascular variation. The bronchovascular variation rate was 11.1% (n=2) in Group 1 and 50% (n=16) in Group 2 (p=0.006). Conclusion: Three-dimensional modeling using open-source software for preoperative planning and intraoperative guidance is a reliable method for detecting bronchovascular structures of the target segment with high accuracy in uniportal video-assisted thoracoscopic surgery segmentectomy.